Brachytherapy Doubles Breast Loss Risk

The American Society for Radiation Oncology has

issued a statement of concern regarding the potential for misinterpretation of

the accelerated partial-breast brachytherapy study. Brachytherapy is a faster,

more convenient alternative to standard whole-breast irradiation, and

brachytherapy technology has improved dramatically since the study years of

2000-2007. Moreover, this was not a randomized trial, and definitive results

from ongoing randomized trials comparing the safety and efficacy of

brachytherapy and standard whole-breast irradiation are still years off. In the

interim, it is appropriate to continue using brachytherapy outside of clinical

trials under selected circumstances as described in a 2009 ASTRO consensus

statement. The first author of the consensus statement was Dr. Benjamin D.

Smith, who presented the brachytherapy findings in San Antonio.

The ASTRO statement (J. Am.

Coll. Surg. 2009;209:269-77) was forged by a task force that conducted an

extensive literature review. Task force members defined a group suitable for

accelerated partial-breast brachytherapy outside of clinical trials based upon

the following characteristics: age 60 years or older, no BRCA mutations, tumor

size not more than 2 cm, T1, estrogen receptor-positive, unicentric and

unifocal, node-negative, no neoadjuvant therapy, no extensive intraductal

component of the breast cancer, and no pure ductal carcinoma in situ. The

consensus statement also defines other patient groups for whom caution must be

applied when considering brachytherapy outside of a clinical trial, as well as

a group for whom such therapy is unacceptable.

The new brachytherapy

study should provide an additional incentive for physicians to be cautious in choosing

which patients to recommend for accelerated partial-breast irradiation. For the

time being, physicians should continue to encourage enrollment in trials and

adhere to a conservative approach to accelerated partial-breast brachytherapy

as indicated in the ASTRO consensus panel statement.

Dr.

Bruce Haffty, a coauthor of the consensus statement, is professor and

chairman of radiation oncology at the Robert

Wood Johnson

Medical School

in New Brunswick, N.J.